=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255423398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY CARE OF WESTERN NORTH CAROLINA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 09/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 S FRENCH BROAD AVE SUITE 300
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-3272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-259-3879
-----------------------------------------------------
Fax | 828-259-3875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 S FRENCH BROAD AVE SUITE 300
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-3272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-259-3879
-----------------------------------------------------
Fax | 828-259-3875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. JENNIFER WEHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-348-2818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------